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Anti-Hyperglycemic Agents and New-Onset Acute Myocardial Infarction in Diabetic Patients with End-Stage Renal Disease

Ting-Tse Lin1,2, Chih-Chen Wu1, Yao-Hsu Yang3,4,5,6

  • 1Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan.

Plos One
|August 12, 2016
PubMed

Insights

For diabetic patients with end-stage renal disease (ESRD), sulfonylureas, meglitinides, and thiazolidinediones (TZD) increase myocardial infarction (MI) risk compared to insulin. This highlights crucial medication choices for managing diabetes in CKD patients.

Area of Science:

  • Nephrology
  • Cardiology
  • Pharmacology

Background:

  • Diabetes and chronic kidney disease (CKD) significantly elevate cardiovascular disease (CVD) risk.
  • Patients with end-stage renal disease (ESRD) face increased myocardial infarction (MI) risk, especially with improved glycemic control.
  • The comparative risk of MI associated with different anti-hyperglycemic agents in ESRD patients is not well-established.

Purpose of the Study:

  • To investigate the association between various anti-hyperglycemic agents and the risk of new-onset MI in diabetic patients with ESRD.
  • To identify which classes of glucose-lowering medications pose a higher cardiovascular risk in this vulnerable population.

Main Methods:

  • Utilized a nationwide Taiwanese database (Registry for Catastrophic Illness) covering nearly all dialysis patients from 1995-2008.
  • Selected a cohort of patients with diabetes and ESRD.
  • Employed propensity score adjustment and Cox proportional hazards regression to estimate hazard ratios (HRs) for MI.

Main Results:

  • Analyzed 15,161 patients: 39% used insulin, 40% sulfonylureas, 18% meglitinides, 3% thiazolidinedione (TZD).
  • After a median follow-up of 1,357 days, sulfonylureas (HR=1.523), meglitinides (HR=1.251), and TZD (HR=1.515) were associated with a significantly increased risk of MI compared to insulin.
  • Subgroup analyses confirmed the elevated MI risk across these medication groups.

Conclusions:

  • In diabetic patients with ESRD on dialysis, sulfonylureas, meglitinides, and TZD are linked to a higher risk of new-onset MI compared to insulin.
  • These findings suggest that insulin may be a safer anti-hyperglycemic choice for diabetic ESRD patients regarding MI risk.
  • Clinical guidelines should consider these risks when prescribing anti-hyperglycemic agents for patients with both diabetes and ESRD.
Abstract

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